tbuckley/cabot-search huggingface dataset:
Abstract 9993: Effect of Major Depressive Disorder on Inpatient Outcomes of Hypertensive Emergency: Analysis From National Inpatient Sample
Authors: Moiz Ehtesham, Muhammad Asim Shabbir
Journal: Circulation (2022)

Objective: Our aim was to determine if co-diagnosis of major depressive disorder (MDD) influenced inpatient outcomes of hypertensive emergency (HTNE) admissions. Methods: We analyzed the national inpatient sample (2012-2019) for HTNE admissions of ages &gt;18 years. The primary outcomes were hospital length of stay (LOS), costs (adjusted for inflation), adverse hospital events (need for mechanical circulatory support and intubation) and in-hospital mortality. Secondary outcomes included predictors of mortality in HTNE patients with MDD. Demographic (age, sex, race) and clinical (history of hypertension, hyperlipidemia, stroke, chronic kidney disease, myocardial infarction, obesity, smoking) factors were adjusted for. Data was analyzed in STATA 16.0, and adjusted odds ratios (AOR) were calculated using linear and logistic regression method. Results: Our study included 149,366 weighted discharges for HTNE. Prevalence of MDD was 9.6% (n=14,339). Average age of the patients were 48 years. 65% were Caucasians, 57% were females and average LOS was 5.5 days. Patients with MDD had longer LOS (6.4 vs 5.1 p&lt;0.001). The adjusted hospital cost was $25,923 higher in patients with MDD (p&lt;0.001), and they also had higher odds of inpatient mortality (AOR 1.76, [1.53 -1.83], P &lt; 0.001). The odds for requiring mechanical circulatory support were higher in patients with MDD (AOR 1.44, P &lt; 0.001). African American men had the highest inpatient costs and LOS. Several conditions increased mortality in HTNE patients with MDD including obesity, cerebrovascular disease (CVD) and end-stage renal disease (ESRD). (Figure 1) Conclusion: Major depressive disorder has an important and unexplored association with hypertension. Our study demonstrates that patients admitted with hypertensive emergency have increased hospital LOS, cost, adverse hospital events and mortality when they have concomitant depression.
Abstract 9969: Number of Calcified Coronary Arteries and Prediction of Cardiovascular Outcomes: The Multi-Ethnic Study of Atherosclerosis
Authors: Tara S Allen, Michael H Criqui, Matthew A Allison, Julie O Denenberg, Harpreet S Bhatia
Journal: Circulation (2022)

Introduction: Current coronary artery calcium (CAC) scoring methods do not account for the number of vessels affected. We assessed the hypothesis that the number of vessels with CAC would be associated with higher risk for incident cardiovascular disease (CVD) outcomes, even after accounting for traditional risk factors, and that adding this metric to current risk scores would improve event prediction. Methods: We analyzed data from 3,255 MESA participants with baseline CAC and event follow-up. Cox proportional hazard regression analyses evaluated the association between number of affected vessels and incident myocardial infarction (MI), hard coronary artery disease (CHD), and hard CVD, adjusting for the ASCVD score and CAC volume and density. Area under the receiver operator curves (AUC) assessed event discrimination by adding number of vessels with CAC to current risk models. Results: At baseline [mean age 66 years (SD 9.6); 1,893 female (58%)], 1,086 participants (33%) had CAC in 1 vessel, 832 in 2 (26%), 987 in 3 (30%), and 385 in 4 (12%). Over a median of 15.5 years, 275 developed MI, 408 CHD, and 598 CVD. Multivariable-adjusted risk was higher with CAC in 3-4 vs 1 vessel for all outcomes (Table) and with 3-4 vs 2-vessels for CHD and CVD (HR 1.36, 95% CI 1.0-1.8 and HR 1.30, 95% CI 1.0-1.6). AUC increased after adding the number of vessels with CAC to the ASCVD score for MI (0.5992 to 0.6645, p=0.002), but not for CHD or CVD, and there was no significant increase for any endpoint when added to models already accounting for CAC volume and density. Conclusions: In a cohort free of baseline CVD, CAC had similar prevalence in 1, 2, and 3 vessels. After accounting for the ASCVD score and CAC volume and density, CAC in 3-4 vessels still conferred a significantly higher risk for adverse CVD outcomes compared to CAC in 1-2 vessels. Moreover, MI risk prediction was improved with adding the number of vessels with CAC to the ASCVD score, but not when also accounting for CAC volume and density.
Abstract 9981: Comparison of 30-day Readmission and Healthcare Costs Between Early and Late Catheter Directed Thrombolysis for Acute Pulmonary Embolism in the United States
Authors: Kwabena S Nketiah Sarpong, Sun-Joo Jang, Ilhwan Yeo, Kavitha Gopalratnam
Journal: Circulation (2022)

Introduction: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5-10% of in-hospital deaths. There is sparse comparative data on readmission patterns and healthcare costs in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE. Hypothesis: Procedure Day for acute PE may be associated with difference in 30-day readmission rates and healthcare costs. Methods: This study was performed by using National readmission database between January 2016 and November 2019. Patients with acute PE who underwent CDT were identified using the International Classification of Diseases, Tenth Edition (ICD 10) codes. Patients who were &lt;18 years old and patients who underwent thrombolysis for STEMI and Ischemic stroke were excluded. Results: Among a total of 23,564 patients who underwent CDT for acute pulmonary embolism, 12,528 (53.2%) were male and 11034 (46.8%) were female (P=0.014). The mean age of the patients was 60.3 years. The median length of hospital stay was 4 days. Thirty-day readmission rates were higher for patients who underwent CDT on Day 2 or afterwards compared to Day 1 and Day 0 (7.1% vs 5.7% vs 5.2%, for day 2, day 1 and day 0 respectively; p=0.016). Patients who had CDT on Day 2 or more had a higher rate of 30-day readmission mortality compared to those who had CDT on Day 1 or 0 (0.6% vs 0.3% vs 0.2%, for day 2, day 1 and day 0 respectively; Adjusted OR 2.96, 95% CI 1.18 to 7.47 (Ref: day 0), p = 0.021). Thirty-day readmission for heart failure was higher among patients who had CDT on Day 2 vs those who had CDT on Day 0 of admission (2% vs 1.0% vs 0.9%, for day 2, day 1 and day 0 respectively; Adjusted OR 1.97, 95% CI 1.24 to 3.13 (Ref: day 0), p=0.004). Total 30-day costs for patients who underwent CDT on day 2 or more was higher in patients with CDT on day 2 ($55,087; IQR $41,361-$74,092) compared to those with CDT on Day 1 ($45,942; IQR $36,016-$61,211) or Day 0 ($44,814; IQR $34,264-$60,072) (P &lt;0.001). Conclusions: Delayed CDT for acute PE was associated with increased rates of 30-day readmission, readmission mortality, readmission for heart failure and increased healthcare costs. These findings emphasize the need for earlier CDT for the treatment of acute PE.
Abstract 9970: Characteristics Associated With Risk-Standardized Acute Admission Rates Among Patients With Heart Failure Enrolled in Accountable Care Organizations
Authors: Sarah Chuzi, Peter Lindenauer, Kamal Faridi, Aruna Priya, Penelope S Pekow, Thomas D'Aunno, Kathleen M Mazor, mihaela stefan, Erica S Spatz, Lauren Gilstrap, Rachel Werner, Tara Lagu
Journal: Circulation (2022)

Introduction: Accountable Care Organizations (ACOs) aim to improve quality and reduce costs of care, but few studies have described variation across ACOs in hospitalization rates for patients with heart failure (HF) or factors associated with hospitalization rates. Methods: We identified a sample of Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program (MSSP) ACO in 2017 and survived at least 30 days into 2018. Using a hierarchical, negative binomial model that accounted for clustering of patients within ACOs, we calculated 2018 risk-standardized, unplanned ACO admission rates (RSAARs) as the ratio of predicted to expected admissions per 100 persons, multiplied by the overall rate of admissions. We then used multiple linear regression to identify ACO characteristics associated with RSAAR variation. Results: Among 1,232,222 beneficiaries with HF, 283,795 were assigned to one of 467 MSSP ACOs (mean age 81 years, 54% female, 86% white, 78% urban). Median RSAAR [IQR] was 87 [82-92] admissions per 100 persons (Figure 1). A 5% increase in the percentage of Black beneficiaries in the ACO corresponded to an increase of 0.65 admissions per 100 HF patients (95% CI 0.31, 0.99, p&lt;0.001). ACOs in the Northeast had higher RSAAR (B=5.16, 95% CI 3.25, 7.07, p&lt;0.001), while ACOs in the West had lower RSAAR (B=-4.36, 95% CI -6.64, -2.09, p&lt;0.001) (Table 1). Conclusions: Among Medicare beneficiaries with HF, there is variation in admission rates across ACOs. Region was strongly associated with RSAAR. Further studies should examine whether regional variation in admission rates is related to ACO quality or regional variation in admission more generally.
Abstract 9954: Single Operator Experience, Learning Curve, and Outcomes With Conduction System Pacing
Authors: William Marion, John Schanz, Sonali Patel, Michael Co, Behzad B Pavri
Journal: Circulation (2022)

Introduction: Conduction system pacing (CSP) is an increasingly used physiologic pacing modality by either His-bundle pacing (HBP) or left-bundle area pacing (LBAP). However, operators new to this technique may hesitate to implement CSP. We describe a single operator's experience (learning curve, clinical outcomes) with CSP from 07/2016-05/2022. Methods: Retrospective analysis of all 3830 Medtronic SelectSecure leads implanted by one operator at an academic institution. Patient characteristics, procedure times, ECG findings, pacing parameters, and clinical outcomes were analyzed. Results: A total of 140 CSP cases (Medtronic 3830 lead) were attempted over 70 months (78 HBP, 62 LBAP). Implant frequency (year → # of cases): 2016 → 3; 2017 → 5; 2018 → 24; 2019 → 25; 2020 → 36; 2021 → 35; 2022 → 12. The last HBP lead was implanted in March 2021; the 1st LBAP lead was implanted in December 2019. There were 23 unsuccessful attempts to achieve CSP at initial implantation (18 in the 1st 34%, mainly HBP cases; 5 in the last 92 cases) and 5 revisions (all HBP, see figure ). Procedure times shortened after the 1st 25 procedures for both HBP (158 to 132 mins, P=0.028) and LBAP (174 to 133 mins, P=0.002). Mean follow-up: HBP=558.2 days and LBAP=109 days. Ten patients (4 HBP, 6 LBAP) were lost to follow up. LBAP leads showed significantly better capture thresholds compared to HBP at implant and follow-up, although QRS narrowing, LV activation times, and improvement in LV function were not significantly different (see table). Conclusion: LBAP is easier to learn and has fewer failure rates as compared to HBP. Procedure times improve with experience within 25 cases. Majority of failed attempts were in the first third of cases, and all but one were in the HBP group. Operators new to CSP should forego HBP and employ LBAP. LBAP provides similar reductions in QRS duration, LV activation times, and LVEF improvement as compared to HBP, but with lower failure/revision rates and superior long-term pacing thresholds.
Abstract 9967: Outcomes of Cardiac Surgery in Patients With Systemic Lupus Erythematosus
Authors: Murad Almasri, Mohamed Elsisy, Yasser Radwan
Journal: Circulation (2022)

Introduction: Patients with systemic lupus erythematosus (SLE) are at increased cardiovascular risk. Data about outcomes after cardiac surgery are scarce. Hypothesis: We sought to evaluate early and late outcomes after cardiac surgery for patients with SLE during a 27- year period at a single institution. Methods: A retrospective review of the institutional Society of Thoracic Surgeons (STS) database between 1993 and 2019 was performed. A total of 329 patients with SLE (median age, 62.4 years, and 68.4% females) had undergone cardiac surgery. Patients’ characteristics and outcomes were analyzed. A logistic regression model was used to assess factors associated with mortality. Results: Incidence of cardiac surgery in patients with SLE has steadily increased with time (0.8% from 1993-2000, 0.9% from 2001-2010, 1.4% from 2011-2019). Of 329 patients, 166 patients (50.5%) had valve surgery, 82 patients (24.9%) had coronary artery bypass grafting (CABG), 48 patients (14.6%) had CABG + valve surgery, and 24 patients (7.3%) had pericardiectomy or pericardial window +/- others procedures. Patients with SLE were more likely to be females, white, older, and have hypertension, diabetes, dyslipidemia, chronic kidney disease, prior myocardial infarction, and congestive heart failure. The requirement of corticosteroids occurred in 91% of patients. The status of surgery was urgent or emergent in 20% of patients. Operative mortality was 4.6% and length of hospital stay was 6.1 days [IQR, 5.1, 9.2]. Overall long-term survival at 1, 5, and 10 years was 89%, 73% and 52%, respectively (Figure). Older age, re-operative dialysis, chronic lung disease, prior cardiac surgery, and dialysis required after surgery were strongly associated with long-term mortality. Conclusion: Cardiac surgery in SLE patients can be performed with acceptable morbidity and mortality. These data are beneficial in risk stratification of patients with SLE referred for cardiac surgery.
Abstract 9971: Distribution of Coronary Artery Calcium and Risk for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Tara S Allen, Michael H Criqui, Matthew A Allison, Mikaila P Reyes, Julie O Denenberg, Harpreet S Bhatia
Journal: Circulation (2022)

Introduction: We tested the hypothesis that specific arteries with coronary artery calcium (CAC) would be associated with higher risk for incident cardiovascular disease (CVD) outcomes, even after accounting for traditional risk factors, and that adding this metric to current risk scores would improve event prediction. Methods: We analyzed data from 3,255 MESA participants with baseline CAC and event follow-up. Cox proportional hazards models assessed the independent associations between CAC presence in each of the main coronary arteries and incident myocardial infarction (MI), hard coronary artery disease (CHD), and hard CVD, adjusting for the ASCVD risk score and CAC volume and density. Area under the receiver operating characteristic curve (AUC) analyses assessed for risk discrimination by adding CAC distribution to existing risk models. Results: At baseline [mean age 66 years (SD 9.6); 1,893 female (58%)], 2,909 (89%) participants had CAC in the left anterior descending (LAD), 1,871 (58%) in the left circumflex (LCx), 1,691 (52%) in the right coronary artery (RCA), and 693 (21%) in the left main (LM). Over a median of 15.5 years, 275 developed MI, 408 CHD, and 598 CVD. After adjustment for the ASCVD risk score and CAC volume and density, only the RCA remained significant for MI and CHD, and was borderline for CVD (Table). AUC increased after adding RCA CAC presence to the ASCVD risk score for MI (0.5992 to 0.6660; 95% CI 0.031-0.102) and CHD (0.6483 to 0.6818; 95% CI, 0.003-0.064), but not for CVD, and there was no significant increase for any endpoints when added to models accounting for CAC volume and density. Conclusion: Prevalent CAC was most common in the LAD, followed by the LCx and RCA. Accounting for risk factors and CAC measures, the RCA was the only artery independently associated with additional MI and CHD risk. Moreover, MI and CHD risk prediction were improved with the addition of CAC distribution to the ASCVD score but not when also accounting for CAC volume and density.
Abstract 9964: Clinical Impact of Handgrip Strength on Prognosis After Percutaneous Coronary Intervention
Authors: Akihiro Tobe, Akihito Tanaka, Yoshinori Shirai, Yoshiaki Kubota, Takeshige Kunieda, Sara Sato, Kenji Furusawa, Hideki Ishii, Toyoaki Murohara
Journal: Circulation (2022)

Introduction: Sarcopenia is defined as age-related loss of skeletal muscle mass and strength, and has been reportedly associated with cardiovascular disease. However, the impact of handgrip strength (HGS) on clinical outcomes after percutaneous coronary intervention (PCI) in patients with coronary artery disease has not been well investigated. Methods: This was a retrospective, single center, observational study. A total of 469 patients who underwent PCI were included. Periprocedural HGS of both hands were measured and of which better value was used for assessment. Patients were divided into 2 groups, low HGS group (men;&lt;28kg, women;&lt;18kg) and high HGS group (men;≥28kg, women;≥18kg) according to the consensus of Asian Working Group for Sarcopenia. The primary outcome was the composite endpoint of all-cause death, myocardial infarction, and heart failure readmission. Results: There were 151 patients in the low HGS group and 318 patients in the high HGS group. The age of patients in the low HGS group was significantly higher (78 [71-82] vs. 70 [61-75] years, p&lt;0.001), while the body mass index and serum albumin level were significantly lower than those in the high HGS group. During the median follow-up period of 778 days, composite endpoint occurred in 35 patients with low HGS and 29 patients with high HGS. The low HGS group had a higher incidence of composite endpoint than the high HGS group (p&lt;0.001) (Figure). The low HGS group had a higher risk of individuals of all-cause, cardiac, and non-cardiac death (p&lt;0.001, respectively). Multivariate Cox proportional hazards analysis showed that low HGS was an independent predictor for the composite endpoint (HR 1.86, 95% CI 1.04-3.33, p=0.04). Conclusions: Low HGS was independently related with long-term cardiac events after PCI.
Abstract 9990: Hypertension Risk Differs by Asian Ethnicity Across the Adult Lifespan
Authors: Irvin Lien, Christopher A Macko, Jamal S Rana, Joan C Lo, Nancy P Gordon
Journal: Circulation (2022)

Introduction: Hypertension risk increases with higher age and body mass index (BMI). We previously found that the prevalence of diagnosed hypertension among Filipino adults is similar to Black adults and higher than White, Chinese, and South Asian adults aged 45-84y. Among young women, the difference between Filipina and Chinese adults was &gt;2-fold. We now examine disparities in hypertension prevalence across the adult lifespan, accounting for differences in weight status. Methods: This cross-sectional study used electronic health record data for 1,018,159 non-Hispanic White (White), 146,517 Black, 348,715 Hispanic, 128,124 Filipino, 126,321 Chinese, and 80,723 South Asian adults aged 30-79 who were members of a Northern California health plan in 2016. Hypertension prevalence (ICD 9/10 diagnosis in 2016) was examined by race/ethnicity and sex for ages 30-39, 40-49, 50-59, 60-69, 70-79y. Poisson regression was used to estimate prevalence ratios (aPRs) for hypertension compared to White adults in each age decade, adjusting for age, English language, current smoking, and BMI category (underweight, healthy weight, overweight, obesity class 1, 2, 3). Lower BMI thresholds were used for Asian adults. Results: Across all age decades, Filipino adults had a prevalence of hypertension similar to Black adults and higher than White, Chinese, and South Asian adults. In each age decade, the Filipino:White aPRs approached or exceeded the Black:White aPRs and were much higher than South Asian:White and Chinese:White aPRs (Figure). Differences in hypertension risk were greatest for those aged 30-59y. Conclusions: Filipino adults, similar to Black adults, had earlier onset and higher prevalence of hypertension than White, Chinese, and South Asian adults across 5 age decades, a disparity that persisted after adjusting for weight status, smoking, and language. These results support the need for earlier and more aggressive blood pressure screening in high-risk populations.
Abstract 9976: Contrasting Mortality Trends of Aortic Emergency: Dissection and Rupture in the UK, Japan, USA, and Canada
Authors: Makoto Hibino, Subodh Verma, Cristian Baeza, Dagfinn Aune, bobby yanagawa, Akihiko Usui, Christoph Nienaber, Marc Pelletier
Journal: Circulation (2022)

Introduction: Aortic dissection and aneurysm rupture are aortic emergencies. Surgical outcomes and interventional procedures have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question. Hypothesis: We hypothesized that given improved surgical mortality, there will be improvement in mortality from aortic dissection and rupture in the UK, Japan, USA, and Canada. Methods: We analyzed the WHO mortality database to determine trends in mortality from aortic dissection and rupture in 4 countries from 2000 to 2019. Crude mortality rate and age-standardized mortality rate per 100,000 persons were calculated, and annual percentage change was estimated using joinpoint regression. Results: In 2019, crude and age-standardized mortality rates from aortic dissection were 2.15 and 1.04 in UK, 8.67 and 2.66 in Japan, 1.21 and 0.76 in USA, and 1.30 and 0.67 in Canada, respectively. In 2019, crude and age-standardized mortality rates from aortic rupture were 4.86 and 1.80 in UK, 5.22 and 1.16 in Japan, 1.04 and 0.52 in USA, and 1.99 and 0.81 in Canada, respectively. There was a significantly decreasing trend in age-standardized mortality from aortic aneurysm rupture in all 4 countries over the study period, and a decreasing trend in age-standardized mortality from aortic dissection in the UK over the study period, in USA until 2010, and in Canada until 2012. There was a significantly increasing trend in mortality from aortic dissection in Japan over the study period, in the USA after 2010, and in Canada after 2012. Joinpoint regression identified significant changes in the trends from decreasing to increasing in USA and Canada. In sensitivity analyses stratified by sex, similar trends were observed. Conclusions: Trends in mortality from aortic aneurysm rupture are decreasing, however, mortality from aortic dissection is increasing in Japan, USA, and Canada. Further study to explain these trends is warranted.